Health system transformation must focus on health equity

Premier Dalton McGuinty’s departure as premier will most certainly bring change to Ontario. But one thing we hope doesn’t change is the provincial government’s commitment to transform our fragmented healthcare system.

What’s required is revolutionary change – delivered in an evolutionary way. And one of the most important changes needed is for system planners to embed a health equity focus into all the new initiatives they roll out this year.

As Health Quality Ontario pointed out in its latest yearly report, “one of the fundamental characteristics of a high-performing healthcare system is being equitable. Inequity in the system can increase death rates, disabilities, distress and discomfort that can prove costly to the healthcare system while jeopardizing its sustainability.”

Great health divide

Here in Ontario, we’re dealing with massive health inequities …. a great health divide that separates the poor from the prosperous, new immigrants and racialized groups from long-time residents and European descendants, Francophones from Anglophones, and Aboriginal peoples from non-Aboriginal populations. The divide also isolates and disadvantages many populations such as lesbian, gay, bisexual and transgendered from accessing the care we need.

The need for action is urgent. Consider just a few of Ontario’s current health inequities:

People living with low incomes are four times more likely to report poor or fair health as people with high incomes. The lowest income groups use the healthcare system twice as much as higher-income Canadians.

Those who live in northern regions lose more years to premature death than the national average.

Immigrant women find it more difficult than Canadian-born women to access the resources they need to stay healthy.

Francophones rate overall health lower than the rest of Ontarians; have a higher rate of heart disease and are less likely to visit a healthcare facility.

South Asians, the largest racialized group in Ontario, have diabetes rates of 11-14%, compared to 5-6% for non-racialized Ontarians.

Lesbian, gay, bisexual and transgendered people have larger health risks, stress and social marginalization and discrimination.

Each and every one of these inequities is preventable.

Prescription needed

Given the growing consensus about the ethical and economic imperatives to promote health equity, it’s worrisome that the province’s new Action Plan for Health Care makes little mention of it. In discussions at various policy tables with the Ministry of Health and Long-Term Care (MOHLTC) and the Local Health Integration Networks (LHINs), we hear that new primary care initiatives will not be “prescriptive.”

But here’s our concern: health disparities are persistent, entrenched and relentless. Unless a proactive and prescriptive approach is applied, we could easily end up with a new system that once again delivers inequitable access. Once again, those who are most vulnerable will be left behind. So it’s crucial both the MOHLTC and the LHINs embed equity considerations into their primary care plans before they start rolling them out.

The right tool’s at hand

Luckily, the Ministry has a powerful tool ready and waiting to assist in equity planning. Developed in 2011 by a large team of internal and external advisors, the Health Equity Impact Assessment tool (HEIA) is designed to assist policymakers in identifying any unintended potential impacts of new initiatives on vulnerable or marginalized groups. If negative impacts are revealed, the tool provides a process to develop strategies to mitigate those impacts.

This coming year, we assume both the province and the LHINs will apply HEIA in a rigourous way as they roll out their new initiatives to transform our healthcare system. For example, with respect to any new primary care networks that are developed, it’s vital to ensure that regions and populations experiencing disparities and inequities get increased access to services from interprofessional primary care teams both willing and able to deal with their complex needs.

As a start, we need interprofessional teams:

with capabilities to develop services for people living in poverty;

equipped to the many stresses faced by newcomers to Canada and racialized groups; and

that engage community members developing and delivering programs that address the root causes of the illness and injury.

Mapping needs

Detailed province-wide mapping and analysis of population needs must be conducted to assess where these types of services should be extended. This will require strong stewardship from the provincial government to ensure a consistent approach throughout all 14 LHINs.

AOHC intends to play a facilitating role. The next edition of Synergy will include news of a report which will reveal which parts of the province have the greatest need for interprofessional primary healthcare services designed for those populations whose health is most at risk.

It is that kind of evidence that drives AOHC’s conviction on health equity as an integral part of primary care transformation in this province.

About Bob Gardner

Bob Gardner was the Director of Policy at Wellesley Institute, 2006-2014. His expertise was in health equity policy working with governments, LHINs, service provider networks, and community partners to develop effective strategies and action plans to enhance health equity. He served on many health policy advisory forums, working groups and boards. Bob has a Ph.D. in sociology; has been an academic, public sector executive and consultant; and has been a community activist on HIV/AIDS, reproductive health, and other issues

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Acknowledgement of Traditional Land

We would like to acknowledge this sacred land on which the Wellesley Institute operates. It has been a site of human activity for 15,000 years. This land is the territory of the Huron-Wendat and Petun First Nations, the Seneca, and most recently, the Mississaugas of the Credit River. The territory was the subject of the Dish With One Spoon Wampum Belt Covenant, an agreement between the Iroquois Confederacy and Confederacy of the Ojibwe and allied nations to peaceably share and care for the resources around the Great Lakes.

Today, the meeting place of Toronto is still the home to many Indigenous people from across Turtle Island and we are grateful to have the opportunity to work in the community, on this territory.

Revised by the Elders Circle (Council of Aboriginal Initiatives) on November 6, 2014

In the spirit of equity and inclusion, if we can improve on this statement, please contact us. Thank you.